Provider Demographics
NPI:1235503046
Name:STEWART, SARAH MELISSA (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MELISSA
Last Name:STEWART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E 11TH CV
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2426
Mailing Address - Country:US
Mailing Address - Phone:479-567-6677
Mailing Address - Fax:479-495-3407
Practice Address - Street 1:408 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:AR
Practice Address - Zip Code:72823-0000
Practice Address - Country:US
Practice Address - Phone:479-495-0651
Practice Address - Fax:479-495-3617
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2551225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPTA2551OtherARKANSAS LICENSE